mother baby + peds Flashcards
teratogenic drugs
TERA-TOWAS thalidomide epileptic meds (valproic acid, phenytoin) retinoid (vit a) ace inhibitors, ARBS third element (lithium) oral contraceptives warfarin alcohol sulfonamides & sulfones
torch infections
infections that can cuase fetal abnormalities TORCH Toxoplasmosis parvOvirus-b19 (fifth disease) Rubella Cytomegalovirus Herpes simplex virus
HELLP syndrome
variant of preeclampsia LIFE THREATENING COMPLICATION Hemolusis ELevated liver enzymes LP low platelet count
magnesium sulfate
remember it acts like a depressant
therapeutic range: 4-7mg/dl
TOXICITY: RR <12 decr DTRs UOP <30 mL/hr EKG changes
ANTIDOTE: calcium gluconate
methergine
action: vasoconstriction
- used to prevent or treat bleeding from the uterus after birth or abortion
contraindicated in people with HTN
hemabate
prostaglandin. .. helps to control BP and muscle contractions (uterine contractions)
* *usually given btw 13 and 20th week**
CONTRAINDICATED in ppl with ASTHMA
mispostol
given rectally
stimulates contraction of the uterine and smooth muscle
what can a baby do at 5 months
grasp rattle
**Remember grasp something with 5 fingers, 5 months!
what can a baby do at 12 months
- walks independently
- sits down from standing position without assistance
- feeds self finger-foods
- draws simple marks on paper
- turns pages in a book
- receptive language (understands common words independent of context… follows one-step gestured command)
- expressive language (first word… uses finger to point to things…imitates:gestures&vocal)
signs of delay at 12 months
after independent walking for several months
- persistent tiptoe walking
- failure to develop a mature walking pattern
signs of delay at 18 months
not walking
not speaking 15 words
does not understand the function of common household items
toddler 18 months
- climbs stairs
- pulls toys
- stacking
- removes shoes and socks
- understands 200 words
- vocab = 15-20 words
toddler 24 months
- right/left handed
- scribbles, paints, imitates strokes
- listens to simple stories
- “my” “mine”
- vocab 40-50 words, sentences 2-3 words
delay: cannot push a toy with wheels… or follow basic instructions
4 years old
- uses scissors
- copies capital letters, draws circle, squares, traces a cross or diamond
- laces shoes
- uses language to engage in make-believe
- count a few numbers
- 1500 words
5 years old
- skip, swim, skate, climb, swing
- use utencils
- mostly cares for own toileting needs
- count to 10
- speech gramatically correct
- 2000 words
peds CPR <12 months
CARDIAC ARREST IN INFANTS IS USUALLY D/T RESP ETIOLOGY
- checks pulse no longer than 10 seconds
- call for help (activate EMS, delagate for someone to call 911/get AED)
- chest compressions
rate 100-120
** two fingers/two thumbs on sternum
**infant 1/3 chest, child 2 inch
single rescuer = 30:2
- continue until signs of help arrive or AED is available
sensorimotor stage
age 0-2
- development thru 5 senses
- development thru motor response
- object permanence
- egocentric = only see the world from one’s own POV
preoperational stage
2-7 years
- symbolic thinking
- imagination *magical, animism, plays pretend
- abstract thinking is difficult
- asks lots of questions
concrete operational stage
7-11 years
- develop concrete cognitive operations sorting blocks in a certain order
- conservation is developed
- conductive reasoning
formal operational stage
> 11
- rational, logical, organized, moral, consistent thinking
- hypothetical thinking
- abstract concepts *love, hate, failures, successes
- deductive reasoning
variations in peds anatomy and physiology
- narrow airways
- nose breathers
- incr metabolic rate, incr O2 requirements
- incr risk for ear infections
- loses heat very easily d/t blood vessels closer to surface
- head and neck muscles are not well developed
- brain is highly vascular = incr risk for hemorrhage
- spine = very mobile = incr risk for cervical spine injury
- immature immune systems, limited exposure to disease
- myelinization is incomplete at birth… happens head to tail
- kidneys are larger in relation to abdomen… less protection… GFR slower
- incr risk for dehydration
SIDS risk factors
- age 1-6 months
- preterm
- sleep position
- sibling death
- nicotine exposure
- socioeconomic status
- lack of prenatal care
- genetic
- bedding
- room temp… cooler = better
education/prevention of SIDS
- sleep in supine position
- firm mattress… no toys, blankets, pillows, stuffed animals
- avoid overdressing infant
- no co-bedding
- normal room temp
- encourage pacifier use
bronchiolitis (RSV)
initial vs continued symptoms
- very contagious, viral illness… starts as URI and moves into chest
initial - upper resp symp (nasal congestion, runny nose, cough, sneezing)
- fever
continued - lower resp symp (tachypnea, cough, wheezing)
emergent bronchiolitis s/s
- grunting
- nasal flaring
- cyanosis
- hypoxia
- resp failure
- apneic episodes
tx of bronchiolitis
- airway maintenance (o2, suctioning, position at 30-40 degree angle)
- hydration
- contact and standard precautions
- hosp only if severe
reyes syndrome
rare disease affecting young children recovering from viral illness (flu or chx pox)
- triggered d/t taking aspirin, alka seltzer, pepto-bismol, kaopectate
s/s
- encephalopathy/cerebral edema
- acute fatty liver failure (incr liver enzymes, incr AST + ALT)
CHILDS Confusion Hyperreflexia Irritability Lethargy Diarrhea and vomitting Seizures
intussusception
ileum telescopes into the cecum –> obstruction = pain –> compression of blood vessels –> blood flow decr –> bowel ischemia –> rectal bleeding (currant jelly stools)
s/s
- intermittent pain and cramping
- draws up legs toward abdomen in severe pain while crying
- diarrhea and vomitting
- currant jelly stools
- lethargy
- sausage shaped mass
tx for intussusception
- IV fluids
- antibiotics
- decompression via NG
- monitor for signs of perforation and shock
- air or barium enema **
pyloric stenosis s/s and tx
s/s - projectile vomiting - non-bilious emesis - olive shape mass palpable in RUQ - hungry despite reg feeds - weight loss - dehydration (incr hematocrit and BUN) - LEADS TO METABOLIC ALKOLOSIS TX - monitor I/Os, signs of dehydration - daily weights - pyloromyotomy
epiglotitis cause/s&s/tx
- caused by hib + steptococcus pneumonia s/s - tripod position - drooling/dysphagia - retractions, nasal flaring - stridor - high fever, sore throat, tachy TX - never leave client, assess O2 status, IV access, calm environment, NPO, do not put in supine position - meds ** antibiotics, antipyretics, corticosteriods, iv fluids
DO NOT PUT TONGUE BLADE IN MOUTH, NO ORAL TEMPS OR THROAT CULTURE
resp condition like croup indicating you need to seek help
PT IN RESP DISTRESS
- child is confused/restless
- blue lips/nails
- incr resp rate
- retractions
- nasal flaring
- drooling/can’t swallow
causes and s/s of croup
causes: parainfluenza virus… leads to inflamation of larynx, trachea and bronchi
s/s inflammation and edema obstruct airway stridor subglottic swelling (hoarseness in voice) seal bark cough
fever management of kid
antipyretics (ibuprofen) s/s of dehydration and electrolyte imbalances sponge bath remove excess clothing to decr temp cool compress on forehead
febrile seizure risk factors, s/s and tx
seizures associated with a fever NOT R/T intracranial infection, metabolic imbalance, viral illness
s/s rapid incr in core temp, child may be drowsy in postictal period risk factors 6 months-5 yrs rapidly developing, HIGH fever family hx certain vaccines = DTP and MMR tx NOT anticonvulsant therapy rectal diazepam educate parents to seek help if >5 mins + repeat
CF patho and diagnosis
- excrine gland disorder w incr production of thick mucus
- autosomal recessive
- leads to mucous plugging
diagnosis - ambry test
- positive sweat sodium chloride test
- genetic screen
tx of CF
PANCREATIC ENZYMES
- chest PT… not done right after meals… helps to break up mucus and strengthen resp muscles
- nebulizers
- prevent GI blockage w fluids and stool softeners
- incr protein, fat, calories, fat soluble vitamins
scarlet fever s/s
complication of group A streptococcal infection
- transmitted via droplets and resp tract secretions
S/S
- onset = abrupt
- red rash –> sandpaper like rash not usually seen on palms and soles of feet
- pharyngitis
- fever, body aches, chills
- strawberry tongue
- tender cervical nodes
- tonsils red
- exudate present
complications + tx of scarlet fever
complications - rhematic fever - glomerulonephritis - abscesses of throat - pneumonia TX - antibiotics *penicillin v* *erythromycin for those allergic* - fluids and soft foods - comfort - cool mist humidifier
